Effect of CPP-ACP pastes with/without fluoride on white spot lesion progression, salivary pH, and fluoride release in high caries risk patients: A randomized clinical trial

Aims: The aim of this article was to evaluate the efficacy of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) with and without fluoride on white spot lesion (WSL) progression, salivary pH, and fluoride ion release compared with fluoridated toothpaste on high caries risk patients. Materials and Methods: A total number of 51 high caries risk participants with occlusal WSLs determined by VistaCam were randomly assessed into three equal groups (n = 17): group 1: CPP-ACP + Fluoridated toothpaste; group 2: CPP-ACFP + Fluoridated toothpaste; group 3: Fluoridated toothpaste only. WSL progression was assessed at baseline, 1 month, and 6 months. The pH values and fluoride ion release assessments were done at baseline, immediately after application, 1 day, 1 week, and 1 month. The pre-treatment and the post-intervention VistaCam scores, salivary pH, and fluoride ion release were tabulated and subjected to statistical analysis. Results: No statistically significant difference in VistaCam scores was found between the tested periods with Tooth Mousse, MI Paste Plus, and Fluoridated tooth paste. There was no statistically significant difference in salivary pH between different evaluation times with Tooth Mousse and control group. MI Paste Plus showed a statistically significant increase in pH value. Regarding fluoride ion release, there was a statistically significant difference between different evaluation periods with MI Paste Plus only. Also, intergroup comparison showed a statistically significant difference in each assessment period. Conclusion: In high caries risk patients, CPP-ACP-containing pastes have a slight remineralization effect like fluoridated toothpaste. The application of CPP-ACFP was effective in raising both salivary pH and fluoride ion release in saliva.